Acromioclavicular Injuries: A "step" forward

Understanding and Managing Acromioclavicular Joint Injuries: A Comprehensive Guide

Introduction:

Acromioclavicular joint injuries (ACJ) are prevalent among athletes, with more significant ones causing what is known aas a "step shoulder", these injuries pose unique challenges due to the demanding nature of their physical activities. This blog aims to provide an in-depth understanding of ACJ injuries, covering anatomy, function, grades, mechanisms of injury, and advanced management strategies based on the latest scientific research from the past decade.

Anatomy and Function:

The acromioclavicular joint, situated at the top of the shoulder, plays a crucial role in the complex mechanics of the shoulder girdle. Comprising the acromion process of the scapula and the lateral end of the clavicle, this joint is stabilised by ligaments and supported by surrounding musculature. Its primary functions include facilitating shoulder movement, transmitting forces between the upper limb and axial skeleton, and providing stability during overhead activities.

Relevant Anatomy:

Understanding the specific anatomy of the ACJ is paramount in comprehending the nature of injuries that can occur. Ligaments such as the acromioclavicular ligament, coracoclavicular ligaments (trapezoid and conoid), and the surrounding capsule collectively contribute to the joint's stability. The intricate network of muscles, including the deltoid, trapezius, and rotator cuff muscles, further influences the dynamic stability of the ACJ.

Grades of ACJ Injuries:

ACJ injuries are commonly classified into six grades, ranging from mild to severe, based on the Rockwood classification system. Grade I involves a mild sprain of the acromioclavicular ligament, while Grade VI indicates a complete dislocation of the joint with marked ligamentous disruption. Intermediate grades encompass a spectrum of injuries with varying degrees of ligamentous involvement.

Mechanisms of Injury:

Athletes are susceptible to ACJ injuries due to the high-intensity and repetitive nature of their training and competition. Mechanisms of injury often include direct impact to the shoulder, falls onto an outstretched hand, or forceful overhead activities. Sports that involve contact, such as football, rugby, and combat sports, present an increased risk of ACJ injuries.

Conservative Management:

Grade I and II injuries typically respond well to conservative management, involving protection, optimal loading, ice, compression, and elevation (POLICE).

Physiotherapy plays a pivotal role in restoring range of motion, strength, and proprioception. Targeted exercises for the shoulder girdle and scapular stabilisers are essential.

For athletes aiming to return to high-performance levels, advanced rehabilitation techniques, including neuromuscular training and sport-specific exercises, are crucial. Proprioceptive training, eccentric strengthening, and dynamic stability exercises can enhance recovery.

Surgical Intervention:

Severe ACJ injuries (Grade III to VI) may necessitate surgical intervention, particularly in elite athletes requiring a rapid return to competition. Surgical options include acromioclavicular joint reconstruction, stabilisation with coracoclavicular fixation, or ligamentous repair based on the specific injury guided by imaging.

Post-Surgical Rehabilitation:

Post-surgical rehabilitation focuses on a gradual return to sport, emphasising progressive strengthening, functional movements, and sport-specific drills.

Close collaboration between the surgeon, physiotherapist, and strength and conditioning coach is essential for optimising outcomes.

Conclusion:

In conclusion, acromioclavicular joint injuries pose a significant challenge for elite athletes, requiring a comprehensive and tailored approach to management. A thorough understanding of the joint's anatomy, the severity of the injury, and the demands of the athlete's sport is crucial for developing effective rehabilitation strategies. The integration of advanced rehabilitation techniques and, when necessary, surgical intervention, can contribute to successful outcomes and a timely return to elite athletic performance.

References:

Deans, C.F., Gentile, J.M., & Tao, M.A. (2019). Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes. Journal of Sports Medicine and Surgery, 1(1), 23-35. DOI: 10.1007/s12178-019-09542-w

LeVasseur, M.R., Mancini, M.R., Berthold, D.P., Cusano, A., McCann, G.P., Cote, M.P., Gomlinski, G., & Mazzocca, A.D. (2021). Acromioclavicular Joint Injuries: Effective Rehabilitation. Open Access Journal of Sports Medicine, 12, 73-85. DOI: 10.2147/OAJSM.S244283

Kelley, N., Tuttle, M.DPT, Sylvia, S.M. MD, Dragoo, J.L. MD, & Khodaee, M. MD, MPH, FACSM. (2023). Acromioclavicular Joint Injuries in Sport. Current Sports Medicine Reports, 22(3), 91-99. DOI: 10.1249/JSR.0000000000001046